Michael R. Harowicz

Jisoo Lee, Michael R. Harowicz, Yuwen Chen et al.

This study evaluates publicly available deep-learning based lung segmentation models in transplant-eligible patients to determine their performance across disease severity levels, pathology categories, and lung sides, and to identify limitations impacting their use in preoperative planning in lung transplantation. This retrospective study included 32 patients who underwent chest CT scans at Duke University Health System between 2017 and 2019 (total of 3,645 2D axial slices). Patients with standard axial CT scans were selected based on the presence of two or more lung pathologies of varying severity. Lung segmentation was performed using three previously developed deep learning models: Unet-R231, TotalSegmentator, MedSAM. Performance was assessed using quantitative metrics (volumetric similarity, Dice similarity coefficient, Hausdorff distance) and a qualitative measure (four-point clinical acceptability scale). Unet-R231 consistently outperformed TotalSegmentator and MedSAM in general, for different severity levels, and pathology categories (p<0.05). All models showed significant performance declines from mild to moderate-to-severe cases, particularly in volumetric similarity (p<0.05), without significant differences among lung sides or pathology types. Unet-R231 provided the most accurate automated lung segmentation among evaluated models with TotalSegmentator being a close second, though their performance declined significantly in moderate-to-severe cases, emphasizing the need for specialized model fine-tuning in severe pathology contexts.

Zhe Zhu, Ehab Albadawy, Ashirbani Saha et al.

Purpose: To determine whether deep learning models can distinguish between breast cancer molecular subtypes based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and methods: In this institutional review board-approved single-center study, we analyzed DCE-MR images of 270 patients at our institution. Lesions of interest were identified by radiologists. The task was to automatically determine whether the tumor is of the Luminal A subtype or of another subtype based on the MR image patches representing the tumor. Three different deep learning approaches were used to classify the tumor according to their molecular subtypes: learning from scratch where only tumor patches were used for training, transfer learning where networks pre-trained on natural images were fine-tuned using tumor patches, and off-the-shelf deep features where the features extracted by neural networks trained on natural images were used for classification with a support vector machine. Network architectures utilized in our experiments were GoogleNet, VGG, and CIFAR. We used 10-fold crossvalidation method for validation and area under the receiver operating characteristic (AUC) as the measure of performance. Results: The best AUC performance for distinguishing molecular subtypes was 0.65 (95% CI:[0.57,0.71]) and was achieved by the off-the-shelf deep features approach. The highest AUC performance for training from scratch was 0.58 (95% CI:[0.51,0.64]) and the best AUC performance for transfer learning was 0.60 (95% CI:[0.52,0.65]) respectively. For the off-the-shelf approach, the features extracted from the fully connected layer performed the best. Conclusion: Deep learning may play a role in discovering radiogenomic associations in breast cancer.

Zhe Zhu, Michael Harowicz, Jun Zhang et al.

Purpose: To determine whether deep learning-based algorithms applied to breast MR images can aid in the prediction of occult invasive disease following the di- agnosis of ductal carcinoma in situ (DCIS) by core needle biopsy. Material and Methods: In this institutional review board-approved study, we analyzed dynamic contrast-enhanced fat-saturated T1-weighted MRI sequences of 131 patients at our institution with a core needle biopsy-confirmed diagnosis of DCIS. The patients had no preoperative therapy before breast MRI and no prior history of breast cancer. We explored two different deep learning approaches to predict whether there was a hidden (occult) invasive component in the analyzed tumors that was ultimately detected at surgical excision. In the first approach, we adopted the transfer learning strategy, in which a network pre-trained on a large dataset of natural images is fine-tuned with our DCIS images. Specifically, we used the GoogleNet model pre-trained on the ImageNet dataset. In the second approach, we used a pre-trained network to extract deep features, and a support vector machine (SVM) that utilizes these features to predict the upstaging of the DCIS. We used 10-fold cross validation and the area under the ROC curve (AUC) to estimate the performance of the predictive models. Results: The best classification performance was obtained using the deep features approach with GoogleNet model pre-trained on ImageNet as the feature extractor and a polynomial kernel SVM used as the classifier (AUC = 0.70, 95% CI: 0.58- 0.79). For the transfer learning based approach, the highest AUC obtained was 0.53 (95% CI: 0.41-0.62). Conclusion: Convolutional neural networks could potentially be used to identify occult invasive disease in patients diagnosed with DCIS at the initial core needle biopsy.